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Gastrointestinal symptoms are common in soldiers in combat or high-pressure operational situations and often lead to compromised performance. Underlying mechanisms are unclear, but neuroendocrine dysregulation, immune activation and increased intestinal permeability may be involved in stress-related Gastrointestinal dysfunction. Dr Li and colleagues evaluated the effects of prolonged, intense, mixed psychological and physical stress on intestinal permeability, systemic inflammatory and stress markers in soldiers during high-intensity combat-training. In 37 male army medical rapid response troops, gastrointestinal symptoms, stress markers, segmental intestinal permeability using the 4-sugar test and immune activation were assessed during the 4th week of an intense combat-training and a rest period. The researchers noted that a combat-training elicited higher stress, anxiety and depression scores as well as greater incidence and severity of gastrointestinal symptoms compared with rest.  | | Segmental gastrointestinal permeability increased during combat-training compared with rest | | Alimentary Pharmacology & Therapeutics |
The IBS-SSS correlated with depression and stress ratings. The team of doctors found that the serum levels of cortisol, interleukin-6, and tumor necrosis factor-α, and segmental gastrointestinal permeability increased during combat-training compared with rest. The lactulose:mannitol ratio was higher in soldiers with gastrointestinal symptoms during combat-training than those without. Dr Li's team concludes, "Prolonged combat-training not only induces the expected increases in stress, anxiety and depression, but also gastrointestinal symptoms, pro-inflammatory immune activation and increased intestinal permeability." "Identification of subgroups of individuals at high-risk of gastrointestinal compromise, and of long-term deleterious effects of operational stress as well as the development of protective measures will be the focus of future studies."
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